EXTRACARDIAC FONTAN OPERATION FOR COMPLEX CARDIAC ANOMALIES - 7 YEARSEXPERIENCE

Methods: Between 1988 and 1995, 60 patients with complex cardiac anoma lies underwent a total extracardiac cavopulmonary connection, a combin ation of a bidirectional cavopulmonary anastomosis with an extracardia c conduit interposition between the inferior vena cava and pulmonary a rteries, except in one patient in whom direct anastomosis was possible . In 30 patients the total extracardiac cavopulmonary connection follo wed preliminary bidirectional cavopulmonary anastomosis, associated wi th a modified Damus-Kaye-Stansel anastomosis in 16. The conduits were constructed of Dacron fabric (n = 34), homografts (n = 3), and polytet rafluoroethylene (n = 22). Results: Total early failure rate was 15% ( n = 9). Six patients died, and three more had conduit take down owing to pulmonary artery stenosis and hypoplasia (n = 2) and severe atriove ntricular valve regurgitation (n = 1). Two other patients required ana stomosis revision owing to stricture. In a mean follow-up of 48 months (6 to SG monthe) there were no late deaths (actuarial 5-year survival 88% +/- 4%); 52 of 54 patients are in New York Heart Association clas s I or II. Two patients required pulmonary artery balloon dilation or stent implantation, or both, after total extracardiac cavopulmonary co nnection. Late tachyarrhythmias were detected in four of 54 patients: two had sick sinus syndrome with Butter necessitating a pacemaker impl antation and two had recurrent Butter (actuarial 5-year arrhythmia-fre e rate 92% +/- 4%). Conduit patency was evaluated by serial magnetic r esonance imaging studies. Preliminary data showed a 17.8% +/- 7.6% mea n reduction in conduit internal diameter during the first 6 months aft er total extracardiac cavopulmonary connection, with no progression ov er the next 5 years. Conclusion: These results demonstrate that the to tal extracardiac cavopulmonary connection provides good early and midt erm results and may reduce the prevalence of late arrhythmias in patie nts undergoing the Fontan operation.